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العنوان
Evaluation of Trials of Labour after Previous Caesarean Section in Ain Shams University Maternity Hospital:
A Retrospective Study /
المؤلف
El Kinawy, Hamdy Bakry Mohye.
هيئة الاعداد
باحث / Hamdy Bakry Mohye El Kinawy
مشرف / Ahmed Ramy Mohammed Ramy
مشرف / Rehab Mohammed Abd El Rahman
مناقش / Rehab Mohammed Abd El Rahman
تاريخ النشر
2016.
عدد الصفحات
P 145. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
أمراض النساء والتوليد
تاريخ الإجازة
1/1/2016
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم امراض النساء والتوليد
الفهرس
Only 14 pages are availabe for public view

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from 145

Abstract

Trial of labour after previous caesarean delivery (TOLAC) provides women who desire a VD with the possibility of achieving that goal––a vaginal birth after caesarean delivery (VBAC).
In addition to fulfilling a patient’s preference for VD, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies (risks of placenta accreta, increased chances of uterine rupture, and the morbidity related to multiple abdominal surgeries). At a population level, VBAC also is associated with a decrease in the overall CS rate.
Proper candidates for planned TOLAC are those women in whom the balance of risks and chances of success are acceptable to the patient and health care provider, and this should be tailored individually.
Although TOLAC is appropriate for many women with a history of a CS, several factors increase the likelihood of a failed TOL, which compared with VBAC, is associated with increased maternal and perinatal morbidity.
The aim of this study was to evaluate the practice and short term maternal and perinatal outcomes of TOLAC offered to women at ASUMH during the 3-year period from January 2013 to December 2015 via a retrospective analysis of the hospital admission records.
The overall success rate was approximately 86%. A prior VD, and particularly a prior VBAC, and presentation in active labour were significantly associated with a higher rate of successful TOL. Lower neonatal birth weight, longer inter-delivery interval and younger maternal age also positively influenced the outcome. Hospital-stay was significantly shorter with successful VBAC.
Maternal adverse events were more frequent among women who had an unsuccessful TOL than among women who had a successful VBAC, including uterine rupture, blood transfusion and endometritis.
Limitation of the present study, being a retrospective one, was the high rate of missing data in the records, hindering regression analysis to identify determinants of success or failure of TOLAC.
To sum up, encouraging TOLAC is considered a robust approach to decrease the rising CS rates. In carefully selected cases, TOL after previous one CS is safe and often successful. Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. If the prerequisites for TOLAC are not available, ERCS is a safer option for delivery.